Muhammad Awais MBBS, Presenter: Nothing to Disclose

Dawar Burhan Khan FRCR, MBBS, Abstract Co-Author: Nothing to Disclose

Danish Barakzai MBBS, Abstract Co-Author: Nothing to Disclose

Abdul Rehman MBBS, Abstract Co-Author: Nothing to Disclose

Naila Nadeem, Abstract Co-Author: Nothing to Disclose

Acute appendicitis is a surgical emergency and accurate timely diagnosis is crucial for improving outcomes. Focused appendiceal computed tomography (FACT) has become one of the primary diagnostic modalities for acute appendicitis. Portable gadgets (like tablets, laptops and smart-phones) have the potential to greatly improve communication between radiologists and surgeons. iPAD, although being small, has sufficiently large display with a long battery life, enabling it to be used as a portable diagnostic imaging console. In the present study, we compared the accuracy of iPAD as a diagnostic console for diagnosing acute appendicitis on FACT using Picture Archival and Communication System (PACS) workstation as reference standard.

Two hundered and twenty five (225) patient underwent FACT at our institution from January, 2012 to June, 2013. All these CT scans were blindly re-interpreted by an independent consultant radiologist first on iPAD version 2.0 and two weeks later, on PACS diagnostic workstation. CT scans were interpreted for the presence of acute appendicitis, location of appendix, phlegmon formation, perforation, appendicolith, free fluid and maximal appendiceal transverse diameter (outer wall to outer wall). Statistical analysis was performed on SPSS version 20. Paired student t-test and kappa statistics were used for comparison. A p-value of less than 0.05 was considered statistically significant.

Ninety nine (99) out of 225 patients had radiological evidence of acute appendicitis on PACS workstation. iPAD was 100% accurate in diagnosing acute appendicitis using PACS workstation as the reference standard. Appendicoliths were identified on PACS workstation in 43, phlegmon in 10, free fluid in 39 and perforation in 12 of the CT scans. Kappa (к) statistics showed excellent agreement between iPAD and PACS workstation for the detection of appendicolith (к =0.945), phlegmon (к=0.817), free fluid (к=0.793) and perforation (к=0.904). Student’s t-test failed to reveal any significant difference (p=0.222) between the mean appendiceal transverse diameter as measured on iPAD (11.511 mm) versus PACS workstation (11.288 mm).

iPAD, as a diagnostic console, was as accurate as PACS workstation for the diagnosis of acute appendicitis on FACT. 

iPAD may be used as an efficient portable imaging console for diagnosing acute appendicitis on FACT.

Awais, M, Khan, D, Barakzai, D, Rehman, A, Nadeem, N, Utility of iPAD as a Diagnostic Console for Detecting Acute Appendicitis on Focused Appendiceal Computed Tomography  .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008242.html